| NPI | 1083215974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: VA 0019008393) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NC LAC-581) |
| 171100000X Acupuncturist (Licence: VA 0121000558) | |
| Enumeration Date | 2020-11-05 |
| Last Update Date | 2020-11-05 |