| NPI | 1750640090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT39020) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT26219) |
| Enumeration Date | 2012-05-07 |
| Last Update Date | 2016-01-07 |