| NPI | 1558734285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: WA RN61451261) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: OR AC 174440) |
| Enumeration Date | 2015-11-03 |
| Last Update Date | 2024-06-05 |