| NPI | 1942735659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 71101) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: CT 71101) |
| 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: NJ 25MB11231200) | |
| 207Q00000X Family Medicine (Licence: NJ 25MB11231200) | |
| 207Q00000X Family Medicine (Licence: PA OT017661) | |
| Enumeration Date | 2017-05-01 |
| Last Update Date | 2022-11-22 |