| NPI | 1396146684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: NY 006438-1) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NJ 18KT00317000) |
| Enumeration Date | 2014-09-06 |
| Last Update Date | 2019-09-13 |