| NPI | 1619389863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: NY 005321) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: WA AC61104893) |
| Enumeration Date | 2014-05-22 |
| Last Update Date | 2022-03-18 |