| NPI | 1710210802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 20197) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 21007) |
| Enumeration Date | 2009-09-08 |
| Last Update Date | 2011-11-11 |