| NPI | 1760874051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: VA 0121000963) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: VA 0019007207) |
| Enumeration Date | 2015-02-24 |
| Last Update Date | 2020-10-12 |