| NPI | 1669698841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: NY 278394) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A7761) |
| 207Q00000X Family Medicine (Licence: NY 278394) | |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2024-06-04 |