| NPI | 1205907482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: NY 02848) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NJ 25MZ00057800) |
| Enumeration Date | 2006-11-10 |
| Last Update Date | 2013-09-30 |