| NPI | 1962531798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: WA MA5703) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: WA AC60347310) |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2013-07-05 |