| NPI | 1730201773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MD C0004363) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: MD UO1334) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2022-01-05 |