| NPI | 1225362262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: NY 023595-1) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY 004185) |
| Enumeration Date | 2009-09-23 |
| Last Update Date | 2024-05-15 |