| 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 |