| NPI | 1952668923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 36016) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA 36016) |
| Enumeration Date | 2012-04-16 |
| Last Update Date | 2024-09-25 |