| NPI | 1609806454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ BA2708418) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: NJ 25MB05525900) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2023-01-05 |