| NPI | 1326589987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 039925) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY 007322) |
| Enumeration Date | 2017-03-15 |
| Last Update Date | 2023-05-01 |