| NPI | 1154170686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: TX AC01362) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: TX MT024345) |
| Enumeration Date | 2024-05-16 |
| Last Update Date | 2024-05-16 |