| NPI | 1548803166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: NY 005975) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NY 032205-01) |
| Enumeration Date | 2019-10-26 |
| Last Update Date | 2025-08-04 |