| NPI | 1215239397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 021102) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY 004021) |
| Enumeration Date | 2010-11-23 |
| Last Update Date | 2018-03-17 |