| NPI | 1013587153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: MD U02824) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: UT 13278692-1201) |
| 171100000X Acupuncturist (Licence: FL TPAP9) | |
| 183700000X Pharmacy Technician (Licence: FL RPT103211) | |
| Enumeration Date | 2021-06-30 |
| Last Update Date | 2026-03-06 |