| NPI | 1891144952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 58502) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P16340) |
| 225100000X Physical Therapist (Licence: CA 293721) | |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2022-10-01 |