| NPI | 1982780268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 200101) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY 001069) |
| 171100000X Acupuncturist (Licence: PA 000551) | |
| 207Q00000X Family Medicine (Licence: PA 071358) | |
| Enumeration Date | 2006-10-28 |
| Last Update Date | 2014-08-15 |