| NPI | 1164475794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: ME 2025) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME 2025) |
| 207Q00000X Family Medicine (Licence: KS 0530213) | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2019-05-31 |