| NPI | 1427374354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS10968) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 255543) |
| 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: FL OS10968) | |
| 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: NY 255543) | |
| Enumeration Date | 2010-04-16 |
| Last Update Date | 2025-10-09 |