| NPI | 1073748430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: VA 0121000668) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: FL AP 2682) |
| 246QM0706X Spec/Tech, Pathology, Medical Technologist (Licence: 167931) | |
| Enumeration Date | 2009-05-28 |
| Last Update Date | 2019-01-03 |