| NPI | 1558638148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TX 2034759) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: TX AC00608) |
| Enumeration Date | 2011-11-26 |
| Last Update Date | 2013-04-27 |