| NPI | 1295929578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: NY 000493) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral |
| 122300000X Dentist (Licence: NY A037303-01) | |
| Enumeration Date | 2007-08-30 |
| Last Update Date | 2023-09-11 |