| NPI | 1215189352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: IL 198.001026) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: WA AC60054005) |
| Enumeration Date | 2008-10-21 |
| Last Update Date | 2013-03-21 |