| NPI | 1083797872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OR PA00314) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: OR AC00093) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2007-10-27 |