| NPI | 1619208428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: VA 0121000516) |
| Additional Taxonomies | 172M00000X Mechanotherapist (Licence: VA 0019002638) |
| Enumeration Date | 2010-01-18 |
| Last Update Date | 2014-04-22 |