| NPI | 1457981953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 053846) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY 006437) |
| Enumeration Date | 2020-01-23 |
| Last Update Date | 2025-03-20 |