| NPI | 1801535406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: VA 0121001055) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: VA 0019017524) |
| Enumeration Date | 2022-06-01 |
| Last Update Date | 2025-10-29 |