NPI | 1104445030 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0100636) |
Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: MD D0100636) |
Enumeration Date | 2020-04-10 |
Last Update Date | 2024-06-27 |