| NPI | 1881601748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT10210) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC19159) |
| 171100000X Acupuncturist (Licence: CA AC3328) | |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2011-10-09 |