| NPI | 1518284496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT 29620) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: CA AC13693) |
| Enumeration Date | 2010-04-30 |
| Last Update Date | 2010-08-04 |