| NPI | 1154547073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 3995) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: IA 3995) |
| 208D00000X General Practice (Licence: IN 02003106A) | |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2019-01-10 |