| NPI | 1568504207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT28833) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: CA AC11597) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2011-12-20 |