| NPI | 1124202478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: CA 13755) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 27860) |
| Enumeration Date | 2007-12-21 |
| Last Update Date | 2019-02-20 |