| NPI | 1669519427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA PT5610) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: CA AC2208) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2025-09-11 |