| NPI | 1669682712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT27651) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CA 060002075) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2010-07-12 |