| NPI | 1265033286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: LA 323918) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: LA La9196) |
| Enumeration Date | 2020-11-05 |
| Last Update Date | 2020-11-05 |