| NPI | 1851604896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT42321) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA PT42321) |
| 225100000X Physical Therapist (Licence: WI 11543-24) | |
| Enumeration Date | 2010-07-20 |
| Last Update Date | 2017-10-12 |