| NPI | 1336107887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS013178) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: PA OS013178) |
| 171100000X Acupuncturist (Licence: PA OKO000013) | |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2025-07-24 |