| NPI | 1356627657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PR 19,926) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY 002548) |
| Enumeration Date | 2011-10-31 |
| Last Update Date | 2015-07-22 |