| NPI | 1801272240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: UT 12358027-1201) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NJ 40QB00281100) |
| Enumeration Date | 2015-08-07 |
| Last Update Date | 2022-01-03 |