| NPI | 1255654893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 010206) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY 000808) |
| Enumeration Date | 2010-03-10 |
| Last Update Date | 2010-03-10 |