| NPI | 1063519726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: CA AC 13995) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ QA009772) |
| 225100000X Physical Therapist (Licence: PA PT016150) | |
| 225100000X Physical Therapist (Licence: CA 33779) | |
| Enumeration Date | 2006-09-17 |
| Last Update Date | 2015-07-07 |