| NPI | 1225615206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2025035705) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: MO 2025035705) |
| Enumeration Date | 2021-03-26 |
| Last Update Date | 2025-09-15 |