| NPI | 1609826759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: NY 120686) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 120686) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2007-07-08 |