| NPI | 1205185428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: OR DO165148) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: OR DO165148) |
| Enumeration Date | 2012-09-04 |
| Last Update Date | 2022-09-23 |