| NPI | 1154092435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: NY 007456) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NY 032391) |
| Enumeration Date | 2021-09-25 |
| Last Update Date | 2023-12-31 |