| NPI | 1447301163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CT 6659) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: CT 239) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2016-09-16 |