| NPI | 1942306345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT37454) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC30305) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2015-08-16 |