| NPI | 1770093312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: CO ACU.0002087) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: CO MT.0018561) |
| Enumeration Date | 2017-10-10 |
| Last Update Date | 2017-10-10 |