| NPI | 1548867591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: CA 18916) |
| Additional Taxonomies | 261QP3300X Clinic/Center, Pain (Licence: CA 18916) |
| Enumeration Date | 2020-10-02 |
| Last Update Date | 2020-10-02 |