| NPI | 1013019090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PR 5648) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: PR 217) |
| 208D00000X General Practice (Licence: PR 5648) | |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2014-11-06 |