| NPI | 1184217572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: VA 0121000655) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: VA 0019004033) |
| Enumeration Date | 2021-02-16 |
| Last Update Date | 2021-02-16 |