| NPI | 1053861245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: WA AC60709575) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 378908) |
| Enumeration Date | 2016-10-11 |
| Last Update Date | 2022-07-21 |