| NPI | 1104088798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 034739) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY 007748) |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2026-03-09 |