| NPI | 1407060106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 014653) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY 000765) |
| 171100000X Acupuncturist (Licence: FL AP 1958) | |
| 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00264900) | |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2014-11-03 |