| NPI | 1629187224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: NY 001079) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 036122) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2007-07-08 |