| NPI | 1316478597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: MD U02601) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: MD M05762) |
| Enumeration Date | 2017-03-21 |
| Last Update Date | 2019-03-01 |