| NPI | 1255628707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MB09393900) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: NJ 25MB09393900) |
| Enumeration Date | 2011-07-06 |
| Last Update Date | 2019-05-09 |