| NPI | 1538415286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: CT 000591) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY 004050) |
| 225700000X Massage Therapist (Licence: NY 019223) | |
| Enumeration Date | 2012-07-31 |
| Last Update Date | 2015-08-31 |