| NPI | 1104058742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: CO ACU 1492) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: WA AC60099399) |
| 225700000X Massage Therapist (Licence: WA MA00023357) | |
| 225700000X Massage Therapist (Licence: CO MT-4817) | |
| Enumeration Date | 2009-08-16 |
| Last Update Date | 2012-09-13 |