| NPI | 1659424208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT24606) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA MPT24606) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2018-06-04 |