| NPI | 1255751418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: WA 61665597) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA 70044229) |
| Enumeration Date | 2014-04-25 |
| Last Update Date | 2026-08-22 |