| NPI | 1497794630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX J4747) |
| Additional Taxonomies | 171100000X Acupuncturist |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2017-01-05 |