| NPI | 1760761811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TN PTA0000006610) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: TN 192) |
| Enumeration Date | 2011-08-08 |
| Last Update Date | 2017-12-06 |