| NPI | 1568458453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 8750) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: SC 8750) |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2020-08-14 |