| 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 |