| NPI | 1902464498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 044985) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY 007900) |
| Enumeration Date | 2019-05-30 |
| Last Update Date | 2026-04-07 |