| NPI | 1609342567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: CA 17984) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CA 2000012464) |
| Enumeration Date | 2018-10-18 |
| Last Update Date | 2018-10-18 |