| NPI | 1578790226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: OR OR 156717) |
| Additional Taxonomies | 174400000X Specialist (Licence: OR Oregon LMT 14129) |
| Enumeration Date | 2009-06-19 |
| Last Update Date | 2012-11-27 |