| NPI | 1255743027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: NY 288908-1) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 288908-1) |
| Enumeration Date | 2014-05-28 |
| Last Update Date | 2020-09-11 |