NPI | 1801224480 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 171100000X Acupuncturist (Licence: MD U02420) |
Additional Taxonomies | 225700000X Massage Therapist (Licence: MD M04274) |
225700000X Massage Therapist (Licence: VA 0019008551) | |
Enumeration Date | 2013-10-17 |
Last Update Date | 2018-04-06 |