NPI | 1952696528 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-07573) |
Additional Taxonomies | 171100000X Acupuncturist (Licence: NC 531) |
Enumeration Date | 2011-06-12 |
Last Update Date | 2021-01-29 |