| NPI | 1780625251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301048249) |
| Additional Taxonomies | 171100000X Acupuncturist |
| 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: MI 4301048249) | |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2009-12-15 |