| NPI | 1083379416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 042377) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY 007726) |
| Enumeration Date | 2021-11-01 |
| Last Update Date | 2025-05-21 |