| NPI | 1790835627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251E1300X Physical Therapist, Electrophysiology, Clinical (Licence: CA PT15984) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: CA PT15984) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: CA PT15984) | |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2007-07-08 |