| NPI | 1902866874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: CA PT7274) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 7274) |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2018-11-19 |