| NPI | 1457492191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: OR 156049) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: 6283) |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2012-03-28 |