| NPI | 1063815793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: CO ACU.0002572) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: CA 16169) |
| Enumeration Date | 2014-10-08 |
| Last Update Date | 2020-06-30 |