| NPI | 1982720710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: OR 3997) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: OR AC00810) |
| 171100000X Acupuncturist (Licence: NY 001396) | |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2010-04-05 |