| NPI | 1689963761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: FL AP3319) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA59658) |
| Enumeration Date | 2011-03-29 |
| Last Update Date | 2023-01-25 |