| NPI | 1609648765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: NY 007866) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NY 033412) |
| Enumeration Date | 2023-10-23 |
| Last Update Date | 2026-04-09 |