| 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 |