| NPI | 1790146843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: NY 001044) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 011079) |
| Enumeration Date | 2016-03-17 |
| Last Update Date | 2019-07-23 |