| NPI | 1245750520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 041675) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY 006874) |
| Enumeration Date | 2017-06-27 |
| Last Update Date | 2022-05-11 |