| NPI | 1659355246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 8196) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: PR 328) |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2012-12-13 |