| NPI | 1538636691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: FL AP1412) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA8491) |
| Enumeration Date | 2018-10-26 |
| Last Update Date | 2018-10-26 |