| NPI | 1285637629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 14885) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: PR 466) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2012-11-01 |