| NPI | 1891039004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 035825-1) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY 006349) |
| Enumeration Date | 2012-11-12 |
| Last Update Date | 2020-09-07 |