| NPI | 1912483439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 040583) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY 007871) |
| Enumeration Date | 2018-07-18 |
| Last Update Date | 2026-08-18 |