| NPI | 1023399755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: MD U02656) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: VA 0121000988) |
| 225200000X Physical Therapy Assistant (Licence: VA 2306603843) | |
| 225200000X Physical Therapy Assistant (Licence: MD A3686) | |
| Enumeration Date | 2011-09-08 |
| Last Update Date | 2021-01-08 |