| NPI | 1528417144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: FL 4392) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: FL 15-01507) |
| Enumeration Date | 2016-06-04 |
| Last Update Date | 2025-01-22 |