| NPI | 1588653687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: NY 0012381) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 0059051) |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2007-07-08 |