| NPI | 1366283822 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 171100000X Acupuncturist (Licence: SC 417) | 
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NC 2222) | 
| 225700000X Massage Therapist (Licence: SC 13596) | |
| Enumeration Date | 2024-06-06 | 
| Last Update Date | 2024-06-06 |