| NPI | 1184128175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: SD 12884) |
| Additional Taxonomies | 174400000X Specialist (Licence: SD 12884) |
| 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: VA 0102205792) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: ID O-1779) | |
| Enumeration Date | 2018-03-22 |
| Last Update Date | 2022-12-09 |