| NPI | 1306502216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: NY 007111-01) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NY 027109) |
| Enumeration Date | 2021-11-15 |
| Last Update Date | 2025-01-02 |