| NPI | 1033198924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: MS 30695) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34007241) |
| 207Q00000X Family Medicine (Licence: AL DO.1891) | |
| 207QS0010X Family Medicine Sports Medicine (Licence: AL DO.1891) | |
| 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: AL DO.1891) | |
| 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: TN 4972) | |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2022-12-19 |