| NPI | 1568073617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: NY 006976) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NY 012541) |
| Enumeration Date | 2020-08-12 |
| Last Update Date | 2024-01-12 |