| NPI | 1588171706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: OR ACC222417) |
| 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: OR 12547) | |
| Enumeration Date | 2018-01-09 |
| Last Update Date | 2024-09-19 |