| NPI | 1164540993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 3406) |
| Additional Taxonomies | 175F00000X Naturopath (Licence: OR 1115R) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2023-01-23 |