| NPI | 1255396719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NM 2074) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NM 866 Rx-1) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2012-09-20 |