| 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 |