| NPI | 1336124627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PR 7399) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: PR 62) |
| Enumeration Date | 2005-12-09 |
| Last Update Date | 2010-11-01 |