| NPI | 1508956798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 202D00000X Integrative Medicine (Licence: AZ 72250) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 239225) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2025-01-19 |