| NPI | 1750428215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT 16018) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 16018) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2017-12-01 |