| NPI | 1194840876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT7373) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: FL AP1549) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2013-06-29 |