| NPI | 1942635503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT41899) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2013033153) |
| Enumeration Date | 2013-09-13 |
| Last Update Date | 2015-06-09 |