| NPI | 1093795478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N8122) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ MB06631300) |
| 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: NJ MB06631300) | |
| 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: TX N8122) | |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2011-09-19 |