| NPI | 1972748549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: DC MD10266) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: DC AC23) |
| Enumeration Date | 2008-12-10 |
| Last Update Date | 2008-12-10 |