| NPI | 1588798367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1075182) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: TX AC00723) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2016-05-03 |