| NPI | 1558302539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT13175) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: FL AP 2921) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2011-01-21 |