| NPI | 1194060756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: FL OS13175) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS13175) |
| 208D00000X General Practice (Licence: FL UO3357) | |
| Enumeration Date | 2012-12-06 |
| Last Update Date | 2019-08-05 |