| NPI | 1578547683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT29126) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CA 29126) |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2019-11-07 |