| NPI | 1417412677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: NY 006471-01) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NY 034192-01) |
| Enumeration Date | 2019-02-01 |
| Last Update Date | 2026-06-30 |