| NPI | 1831481654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 41397) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: CA AC14093) |
| Enumeration Date | 2011-05-12 |
| Last Update Date | 2014-06-25 |