| NPI | 1881025294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1360285) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: TX AC01482) |
| Enumeration Date | 2013-12-10 |
| Last Update Date | 2023-08-29 |