| NPI | 1023073897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M10114) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: ID M10114) |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2013-07-24 |