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 |