| NPI | 1184667883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2005-1297) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: NC 2005-1297) |
| 207RA0201X Internal Medicine Allergy & Immunology (Licence: NC 20051297) | |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2023-03-07 |