| NPI | 1053481374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: WA ac2144) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA MA 14529) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2022-06-02 |