| NPI | 1053962936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT41344) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: CA AC18612) |
| Enumeration Date | 2019-09-23 |
| Last Update Date | 2024-05-04 |