| NPI | 1912498353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 302322) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY A302322) |
| 207R00000X Internal Medicine (Licence: NY 302322) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: NY 302322) | |
| 208D00000X General Practice (Licence: NJ 25MA11832000) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-05-22 |
| Last Update Date | 2023-07-11 |