| NPI | 1912320813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: CA 13718) |
| Additional Taxonomies | 171100000X Acupuncturist |
| 225700000X Massage Therapist (Licence: CA 59826) | |
| Enumeration Date | 2014-01-28 |
| Last Update Date | 2021-08-05 |