| NPI | 1124075114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101031261) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: VA 0101-031261) |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2020-05-21 |