| NPI | 1114152311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 015873) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY 002958) |
| Enumeration Date | 2009-05-18 |
| Last Update Date | 2016-05-28 |