| NPI | 1972645083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 35162) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 29301) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2020-10-01 |