| NPI | 1063808269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MB10551600) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: NJ 25MB10551600) |
| Enumeration Date | 2015-04-14 |
| Last Update Date | 2020-11-24 |