| NPI | 1265558373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT016630) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: PA AK000999) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2015-04-20 |