| NPI | 1114191301 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: MA 230120) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: MA 303) |
| Enumeration Date | 2008-04-17 |
| Last Update Date | 2015-05-06 |