| NPI | 1407280548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: NY 25005137) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: NY 958192) |
| Enumeration Date | 2013-08-26 |
| Last Update Date | 2019-08-15 |