| NPI | 1285350512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: NY 018775-01) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY 018775-01) |
| Enumeration Date | 2022-10-18 |
| Last Update Date | 2022-10-18 |