| NPI | 1831166495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: CA PT6596) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT6596) |
| Enumeration Date | 2006-03-02 |
| Last Update Date | 2010-04-26 |