| NPI | 1659442002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 125638) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY A125638) |
| 207Q00000X Family Medicine (Licence: NY A125638) | |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2013-12-13 |