| NPI | 1023231115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 3736) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: SC ACUP201) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2021-11-03 |