| NPI | 1154843456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: WA AC60918779) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: CA AC17491) |
| Enumeration Date | 2017-07-09 |
| Last Update Date | 2020-05-23 |