| NPI | 1124521182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 05152) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: KY 05152) |
| Enumeration Date | 2018-03-15 |
| Last Update Date | 2023-03-01 |