| NPI | 1043382468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NY 012350-1) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY 02766) |
| 225100000X Physical Therapist (Licence: VA 0121000387) | |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2021-04-23 |