| NPI | 1356905798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: FL 4598) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL 98588) |
| Enumeration Date | 2019-04-30 |
| Last Update Date | 2024-10-01 |