| NPI | 1639269913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: MI 4301117103) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: PR 587) |
| 207Q00000X Family Medicine (Licence: MI 4301117103) | |
| 208D00000X General Practice (Licence: PR 15953) | |
| Enumeration Date | 2006-10-15 |
| Last Update Date | 2023-03-02 |