| NPI | 1679617310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: AZ 0103) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: VT 0910000028) |
| 225700000X Massage Therapist (Licence: AZ MT03746P) | |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2007-07-08 |