| NPI | 1063765709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: TX AC01245) |
| Additional Taxonomies | 246ZE0600X Specialist/Technologist, Other, Electroneurodiagnostic (Licence: TX 3549) |
| Enumeration Date | 2012-10-18 |
| Last Update Date | 2022-07-21 |