| NPI | 1235119215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MO 118085) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: MO 118085) |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2020-03-12 |