| NPI | 1760415566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT24728) |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: CA PT24728) |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2022-08-02 |