| NPI | 1427004670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 026695) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY 005569) |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2024-04-18 |