| NPI | 1760989750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL 11004373) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: FL 3933) |
| Enumeration Date | 2018-04-07 |
| Last Update Date | 2019-12-28 |