| NPI | 1891855904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 4232-033) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: WI 303) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2017-02-06 |