| NPI | 1033110275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 8159) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PR 8159) |
| 171100000X Acupuncturist (Licence: PR 8159) | |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2010-12-07 |