| NPI | 1013336841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: FL AP-4155) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA-99751) |
| Enumeration Date | 2014-04-09 |
| Last Update Date | 2023-08-10 |