| NPI | 1699368639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: NC LAC-2042) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH14751) |
| Enumeration Date | 2021-02-19 |
| Last Update Date | 2021-02-19 |