| NPI | 1073237400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 043734) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY 007776) |
| Enumeration Date | 2022-09-29 |
| Last Update Date | 2025-08-08 |