| NPI | 1467799668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 035944-1) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY 003776-1) |
| Enumeration Date | 2013-01-08 |
| Last Update Date | 2023-08-31 |