| NPI | 1730619032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: CA AC7602) |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: CA AC7602) |
| Enumeration Date | 2017-06-19 |
| Last Update Date | 2017-06-19 |