| NPI | 1669514121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: WA AC00002358) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA MA00018165) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2007-09-13 |