| NPI | 1952362238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ME 009232) |
| Additional Taxonomies | 171100000X Acupuncturist |
| 207Q00000X Family Medicine (Licence: VA 0101239177) | |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2024-11-17 |