Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225700000X | Massage Therapist | 027893-1 | NY |
Y | 225700000X | Massage Therapist | 18KT00654600 | NJ |
NPI | 1013364579 |
---|---|
Provider Name | Alexander K Ahn |
First Address | Hoboken, NJ 07030-5617 |
Second Address | Hoboken, NJ 07030-5617 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2016 |
Last Update Date | 15/05/2016 |