| NPI | 1356663306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME135224) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: FL AP2554) |
| 208D00000X General Practice (Licence: PR 018321) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 12848-I) | |
| Enumeration Date | 2010-02-18 |
| Last Update Date | 2022-04-06 |