| NPI | 1952899502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: CA PT294376) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 294376) |
| Enumeration Date | 2018-04-30 |
| Last Update Date | 2020-12-10 |