| NPI | 1427226828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MA 268661) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: MA 363) |
| Enumeration Date | 2008-02-19 |
| Last Update Date | 2011-05-05 |