| NPI | 1619053956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 10338) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: PR 10338) |
| Enumeration Date | 2006-10-30 |
| Last Update Date | 2023-11-15 |