| NPI | 1962895342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: CA 20342) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: WA AC 60432768) |
| Enumeration Date | 2015-03-10 |
| Last Update Date | 2025-04-30 |