| NPI | 1184704967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 39223) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: SC 39223) |
| 207Q00000X Family Medicine (Licence: NE 24324) | |
| 207Q00000X Family Medicine (Licence: VA 0101238560) | |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2024-07-31 |