| NPI | 1023239803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: AZ 090455) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: AZ 410) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2007-07-08 |