Individual
DAT ON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.AC.
Contact information
Practice address
5904 N EL DORADO ST, STE A, STOCKTON, CA 95207-4467
(209) 898-7525
(209) 898-7525
Mailing address
5904 N EL DORADO ST, STE A, STOCKTON, CA 95207-4467
(209) 898-7525
(209) 898-7525
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
AC14184
CA
Other
Enumeration date
04/09/2011
Last updated
02/02/2016
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