| NPI | 1386113819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 033109) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY 6765) |
| Enumeration Date | 2018-11-14 |
| Last Update Date | 2023-03-24 |