| NPI | 1548586365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: NY 25 P86184) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA46960) |
| Enumeration Date | 2010-04-19 |
| Last Update Date | 2012-10-22 |