| NPI | 1942731179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: KY AC128) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: KY A03453) |
| Enumeration Date | 2017-03-21 |
| Last Update Date | 2020-02-05 |