| NPI | 1457340713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT8264) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC16918) |
| Enumeration Date | 2005-10-19 |
| Last Update Date | 2016-02-12 |