| NPI | 1699988535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 035727) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY 003214) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2020-12-09 |