| NPI | 1134504301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: MD UI02152) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: MD M04891) |
| Enumeration Date | 2015-07-29 |
| Last Update Date | 2018-10-09 |