| NPI | 1770993636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: CA 16965) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: RI DA00454) |
| 225700000X Massage Therapist (Licence: CA CMT 12010) | |
| Enumeration Date | 2014-04-30 |
| Last Update Date | 2022-02-04 |