| NPI | 1760755078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: ND 2021-01) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: WA AC60179457) |
| 171100000X Acupuncturist (Licence: OR AC150373) | |
| Enumeration Date | 2012-02-16 |
| Last Update Date | 2021-10-19 |