| NPI | 1770887978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS18288) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: NY 259837) |
| 207Q00000X Family Medicine (Licence: VA 0102205588) | |
| 207Q00000X Family Medicine (Licence: NY 259837) | |
| 207Q00000X Family Medicine (Licence: WV 3461) | |
| 208D00000X General Practice (Licence: NY 259837) | |
| Enumeration Date | 2011-01-03 |
| Last Update Date | 2023-11-06 |