| NPI | 1730582214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5017531) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: WI 842-55) |
| Enumeration Date | 2014-09-29 |
| Last Update Date | 2023-04-12 |