| NPI | 1720622947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: NY 007420) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NY 007672) |
| 225100000X Physical Therapist (Licence: FL 43055) | |
| Enumeration Date | 2019-10-30 |
| Last Update Date | 2025-09-29 |