| NPI | 1437709961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: WA AC60966029) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA MA60585565) |
| Enumeration Date | 2019-09-17 |
| Last Update Date | 2025-08-13 |