| NPI | 1891828034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: FL 4177) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 20871) |
| 225100000X Physical Therapist | |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2021-07-15 |