| NPI | 1518964279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 3629) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: AZ 0375) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2011-04-07 |