NPI | 1639674328 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102205793) |
Additional Taxonomies | 171000000X Military Health Care Provider |
171100000X Acupuncturist (Licence: VA 0102205793) | |
Enumeration Date | 2018-03-26 |
Last Update Date | 2021-09-26 |