| NPI | 1760013338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: NY 032046) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY 007433-01) |
| Enumeration Date | 2020-01-31 |
| Last Update Date | 2025-05-01 |