| NPI | 1184747305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: NY 167000) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 167000) |
| 207Q00000X Family Medicine (Licence: CT 000278) | |
| 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: CT 000278) | |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2016-09-13 |