| NPI | 1912220302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: FL AP4192) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA93722) |
| Enumeration Date | 2010-03-12 |
| Last Update Date | 2026-01-15 |