| NPI | 1780119404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NY 329191) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY 329191) |
| 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: NY 329191) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL OS22114) | |
| 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: FL OS22114) | |
| Enumeration Date | 2017-05-01 |
| Last Update Date | 2026-05-21 |