| NPI | 1205457603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: AZ 011429) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 011429) |
| Enumeration Date | 2020-04-27 |
| Last Update Date | 2025-01-06 |