| NPI | 1952708836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: NY 25 005638) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NY 27 027747) |
| Enumeration Date | 2014-11-20 |
| Last Update Date | 2015-09-25 |