| NPI | 1851375059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT12822) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: CA PT12822) |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2022-06-27 |