NPI | 1093785651 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: NY 167350) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 1673501) |
Enumeration Date | 2006-01-25 |
Last Update Date | 2014-01-27 |