| NPI | 1821184235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA 12998) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: CA 3835) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2010-06-08 |