| NPI | 1629758792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: VA 0121001251) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: FL AP4492) |
| Enumeration Date | 2023-07-24 |
| Last Update Date | 2026-03-27 |