| NPI | 1609215672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: NY 292341) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: NY 292341) |
| 208D00000X General Practice (Licence: NC 2014-01962) | |
| Enumeration Date | 2013-06-22 |
| Last Update Date | 2021-08-04 |