| NPI | 1518215888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: OR AC186592) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: OR 21121) |
| Enumeration Date | 2012-08-16 |
| Last Update Date | 2026-04-07 |