| NPI | 1255485660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: WA 154) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: ID ACU8) |
| 171100000X Acupuncturist (Licence: MT 116) | |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2007-07-08 |