| NPI | 1720371636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2018037130) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: FL AP2975) |
| Enumeration Date | 2011-05-25 |
| Last Update Date | 2020-08-17 |