| NPI | 1558604769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: FL AP3220) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA68681) |
| Enumeration Date | 2013-04-05 |
| Last Update Date | 2016-07-07 |