| NPI | 1225141641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: MO 2012034290) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: MT 131811) |
| 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: UT 11624821-8904) | |
| 207Q00000X Family Medicine (Licence: MI Certificate 8677) | |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2024-03-14 |