| NPI | 1003249004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9113748) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: CA AC 15206) |
| 171100000X Acupuncturist (Licence: FL AP 3783) | |
| Enumeration Date | 2013-08-13 |
| Last Update Date | 2020-11-06 |