| NPI | 1275558256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT21731) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: CA AC8251) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2012-11-29 |