| NPI | 1710136429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: PA OS015703) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: PA OKO000039) |
| 207Q00000X Family Medicine (Licence: PA OS015703) | |
| Enumeration Date | 2008-09-17 |
| Last Update Date | 2012-09-07 |