| NPI | 1730151218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 194198) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: NY 194918) |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2012-09-11 |