| NPI | 1992960587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 10210) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NC 348) |
| Enumeration Date | 2008-07-23 |
| Last Update Date | 2020-03-31 |