| NPI | 1093109522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY A289476) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY A289476) |
| 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: NY A289476) | |
| Enumeration Date | 2015-03-23 |
| Last Update Date | 2025-06-03 |