| NPI | 1619637402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: NY 007033) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NY 019277) |
| Enumeration Date | 2021-12-21 |
| Last Update Date | 2025-11-09 |