| NPI | 1114995024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO CDRH.0038620) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: CO CDRH.0038620) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2024-03-27 |