| NPI | 1801973540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT32518) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 32518) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2016-10-03 |