| NPI | 1659810190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: NY 005922) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NY F310958-01) |
| Enumeration Date | 2017-02-16 |
| Last Update Date | 2022-11-07 |