NPI | 1093035636 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS18284) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 277954) |
204D00000X Neuromusculoskeletal Medicine & OMM (Licence: NY 277954) | |
Enumeration Date | 2010-06-06 |
Last Update Date | 2022-04-05 |