| NPI | 1982649539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PR 5393) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: PR 5393) |
| Enumeration Date | 2006-06-18 |
| Last Update Date | 2021-10-06 |