| NPI | 1033164686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD030209E) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: PA AK000136L) |
| 207Q00000X Family Medicine (Licence: NJ 25MA04249800) | |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2021-12-16 |