| NPI | 1609880111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251E1300X Physical Therapist, Electrophysiology, Clinical (Licence: CA EN8) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT3422) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2008-10-16 |