| NPI | 1902147499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 031899) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY 006977) |
| Enumeration Date | 2013-03-07 |
| Last Update Date | 2022-02-28 |