| NPI | 1912172438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT25134) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: RI 02322) |
| 171100000X Acupuncturist (Licence: CA 16420) | |
| Enumeration Date | 2008-04-25 |
| Last Update Date | 2019-04-25 |