| NPI | 1659775773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: NY 005391-1) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: PA AK001125) |
| Enumeration Date | 2014-10-17 |
| Last Update Date | 2022-01-04 |