| NPI | 1578599528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: FL OS16010) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: NY 199975-1) |
| 207Q00000X Family Medicine (Licence: FL OS16010) | |
| 207Q00000X Family Medicine (Licence: NY 199975-1) | |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2023-03-20 |