| NPI | 1275005662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: MD u02574) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: MD M05571) |
| Enumeration Date | 2018-12-22 |
| Last Update Date | 2023-10-25 |