| NPI | 1154472546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 025055) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY 7437) |
| 171100000X Acupuncturist (Licence: CA AC8570) | |
| 171100000X Acupuncturist (Licence: NJ 25MZ00169700) | |
| 363A00000X Physician Assistant (Licence: NJ 25MP00577600) | |
| 363A00000X Physician Assistant (Licence: CA PA18721) | |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2024-01-12 |