| NPI | 1760530828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT 3806) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: FL AP 461) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2008-06-05 |