| NPI | 1760657191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 6109-24) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: WI 300) |
| Enumeration Date | 2008-04-27 |
| Last Update Date | 2026-04-27 |