| NPI | 1659626240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 37327) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA 37327) |
| 283X00000X Rehabilitation Hospital | |
| Enumeration Date | 2012-07-19 |
| Last Update Date | 2021-11-29 |