| NPI | 1962881375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS021391) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: PA OKO000074) |
| Enumeration Date | 2015-05-19 |
| Last Update Date | 2022-09-29 |