| NPI | 1902165806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: GA 000308) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: CA 14337) |
| Enumeration Date | 2012-05-11 |
| Last Update Date | 2016-06-01 |