| NPI | 1467663518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: NY 013135) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY 003811) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2020-10-19 |