| NPI | 1245668508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: OR AC189999) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA MA60401348) |
| 225700000X Massage Therapist (Licence: OR 19300) | |
| Enumeration Date | 2013-10-24 |
| Last Update Date | 2018-12-21 |