| NPI | 1740621960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: NY 25 005223) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 62 023662) |
| Enumeration Date | 2013-07-16 |
| Last Update Date | 2019-10-14 |