| NPI | 1790992824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: WA 502) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WA 29819) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2007-07-08 |