| NPI | 1235308784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 259884) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY A259884-1) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: NY 259884) | |
| Enumeration Date | 2008-02-28 |
| Last Update Date | 2014-07-07 |