| NPI | 1710123567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: OR 01234) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: CA 12719) |
| Enumeration Date | 2008-12-29 |
| Last Update Date | 2008-12-29 |