| NPI | 1568125045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: FL AP4262) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA104693) |
| Enumeration Date | 2021-10-20 |
| Last Update Date | 2026-05-22 |