| NPI | 1174391445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: NY 007614) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NY 032050) |
| Enumeration Date | 2023-12-18 |
| Last Update Date | 2024-11-24 |