| NPI | 1164644589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 135373-1) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: NY 135373-1) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2007-07-08 |