| NPI | 1265556351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 014113) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY 001884-1) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2014-08-08 |