| NPI | 1821076852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA pt19092) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA dc25455) |
| Enumeration Date | 2006-01-09 |
| Last Update Date | 2009-05-18 |