| NPI | 1679912463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: CA 15697) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA Massage CAMTC #27258) |
| 225700000X Massage Therapist (Licence: CA 27258) | |
| Enumeration Date | 2013-06-14 |
| Last Update Date | 2023-02-07 |