| NPI | 1801256243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95027428) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: UT 7070814-1201) |
| Enumeration Date | 2016-02-27 |
| Last Update Date | 2024-08-21 |