| NPI | 1184269318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 039234) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY 007326) |
| Enumeration Date | 2019-11-12 |
| Last Update Date | 2024-03-09 |