| NPI | 1811604143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: MD U03168) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA92237) |
| Enumeration Date | 2022-11-07 |
| Last Update Date | 2025-06-22 |