| NPI | 1154355253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: NY 231035) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 231035) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2016-07-20 |