| NPI | 1619387453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA PT 40783) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0014183) |
| Enumeration Date | 2014-05-01 |
| Last Update Date | 2016-08-17 |