| NPI | 1790194553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: NY 005371) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NY 019614) |
| Enumeration Date | 2014-08-06 |
| Last Update Date | 2018-03-17 |