| NPI | 1699052159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 033956) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY 005315) |
| Enumeration Date | 2011-11-11 |
| Last Update Date | 2016-01-22 |