| NPI | 1053315556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: LA L03356R) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: LA 03356) |
| 171100000X Acupuncturist (Licence: LA 200010) | |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2007-12-03 |