| NPI | 1619173689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT7339) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: FL AP544) |
| Enumeration Date | 2007-06-26 |
| Last Update Date | 2022-07-21 |