| NPI | 1083713812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2012-01175) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: NC 2012-01175) |
| 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: ME 1821) | |
| 207Q00000X Family Medicine (Licence: ME 1821) | |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: NC 2012-01175) | |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2024-06-21 |