| NPI | 1811565575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251N0400X Physical Therapist, Neurology (Licence: CA 300475) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA 211459) |
| Enumeration Date | 2021-06-17 |
| Last Update Date | 2021-07-20 |