| NPI | 1578983243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT 35831) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA PT35831) |
| Enumeration Date | 2014-04-22 |
| Last Update Date | 2019-12-16 |