| NPI | 1245267970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 182685-1) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: NY 182685-1) |
| 208D00000X General Practice (Licence: NY 182685-1) | |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2008-06-06 |