| NPI | 1740756477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: MD U02901) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: MD M05893) |
| Enumeration Date | 2018-10-20 |
| Last Update Date | 2025-08-05 |