| NPI | 1972058436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA PT300594) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 11144) |
| Enumeration Date | 2016-08-24 |
| Last Update Date | 2022-06-09 |