| NPI | 1417956848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11011629) |
| Additional Taxonomies | 171100000X Acupuncturist |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2025-10-29 |