| NPI | 1497873442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 6002) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: PR 83) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2010-03-28 |