| NPI | 1033500939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C08599) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: PA nvXyuhVA) |
| Enumeration Date | 2015-02-12 |
| Last Update Date | 2022-09-19 |