| NPI | 1295027456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 030089) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY 006540) |
| Enumeration Date | 2011-05-06 |
| Last Update Date | 2026-04-07 |