| NPI | 1023373685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: NY 003747) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NY 025164) |
| Enumeration Date | 2012-07-10 |
| Last Update Date | 2019-06-04 |