| NPI | 1366736902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 265720) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: NY 265720) |
| 207Q00000X Family Medicine (Licence: ME DO2422) | |
| Enumeration Date | 2011-05-31 |
| Last Update Date | 2021-06-22 |