| NPI | 1528187507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: NY 003477) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 16067) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2025-09-11 |