| NPI | 1487350005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: AZ LAC-011396) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: AZ MT-24179) |
| Enumeration Date | 2023-02-06 |
| Last Update Date | 2023-02-06 |