| NPI | 1730482159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: VA 0121000947) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: VA 19003726) |
| Enumeration Date | 2010-12-07 |
| Last Update Date | 2021-08-31 |