| NPI | 1508334194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: OR AC191454) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: OR 24319) |
| Enumeration Date | 2018-11-13 |
| Last Update Date | 2018-12-30 |