| NPI | 1063589323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: OR 14335) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OR 14335) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2023-03-07 |