| NPI | 1184349227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: NY 033107) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY 007679) |
| Enumeration Date | 2022-10-11 |
| Last Update Date | 2025-05-07 |