| NPI | 1417976853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: MD U000686) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C0001384) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2014-09-04 |