| NPI | 1912962473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: NY 206232) |
| Additional Taxonomies | 133NN1002X Nutritionist, Nutrition, Education (Licence: NY 206232) |
| 171100000X Acupuncturist (Licence: NY 206232) | |
| 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: NY 206232) | |
| 208D00000X General Practice (Licence: NY 206232) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: NY 206232) | |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2014-09-04 |