| NPI | 1497764781 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 171100000X Acupuncturist (Licence: CA 10882)  | 
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 18136)  | 
| Enumeration Date | 2006-08-05 | 
| Last Update Date | 2025-09-11 |