| NPI | 1598823882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT5573) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT5573A) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2008-04-02 |