| NPI | 1801124474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: WA AC60114046) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA MA00023193) |
| Enumeration Date | 2009-11-19 |
| Last Update Date | 2012-11-04 |