| NPI | 1770854820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT41177) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: CA AC13887) |
| Enumeration Date | 2012-01-21 |
| Last Update Date | 2016-08-15 |