| NPI | 1801033899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: MD UO1179) |
| Additional Taxonomies | 172M00000X Mechanotherapist (Licence: MD M02382) |
| Enumeration Date | 2009-01-13 |
| Last Update Date | 2009-01-13 |