| NPI | 1730328345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 429365-1) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY 001446) |
| Enumeration Date | 2009-02-05 |
| Last Update Date | 2014-11-10 |