| NPI | 1669943957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT295211) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CA 295211) |
| Enumeration Date | 2018-12-11 |
| Last Update Date | 2020-06-30 |