| NPI | 1053537696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: MA 51) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 3012) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2009-06-19 |