| NPI | 1679683825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 41367) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC30165) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2014-06-14 |