| NPI | 1558359786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 245204) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY A245204) |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2012-09-27 |