| NPI | 1477536720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 4721) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: PR 4721) |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2020-03-11 |