| NPI | 1730496936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: NY 000615) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NY 001141) |
| 225700000X Massage Therapist (Licence: NY 005372) | |
| Enumeration Date | 2010-09-09 |
| Last Update Date | 2020-12-29 |