| NPI | 1013587153 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 171100000X Acupuncturist (Licence: UT 13278692-1201) | 
| Additional Taxonomies | 171100000X Acupuncturist (Licence: FL TPAP9) | 
| 171100000X Acupuncturist (Licence: MD U02824) | |
| 183700000X Pharmacy Technician (Licence: FL RPT103211) | |
| Enumeration Date | 2021-06-30 | 
| Last Update Date | 2024-04-07 |