| NPI | 1235122599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 13507) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: PR 13507-469) |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2021-10-06 |