| NPI | 1982772778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 23495) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: MD U01848) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2016-08-05 |