| NPI | 1063773240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: WA AC 60268399) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA MA 60268328) |
| Enumeration Date | 2012-06-04 |
| Last Update Date | 2012-06-04 |