| NPI | 1114115326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: 152906) |
| Additional Taxonomies | 171100000X Acupuncturist |
| 225200000X Physical Therapy Assistant (Licence: TX 2064720) | |
| 225200000X Physical Therapy Assistant (Licence: GA PTA004438) | |
| Enumeration Date | 2007-10-12 |
| Last Update Date | 2021-08-25 |