| NPI | 1548656317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: WA AC 60704819) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA MA60507214) |
| Enumeration Date | 2015-04-08 |
| Last Update Date | 2022-07-21 |