| NPI | 1104992718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: NY 003995) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NY 012347) |
| 171100000X Acupuncturist (Licence: NJ 25MZ00053400) | |
| Enumeration Date | 2006-11-27 |
| Last Update Date | 2007-07-08 |