| NPI | 1235699299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: CA 20A22433) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: OH 34.015518) |
| 207Q00000X Family Medicine (Licence: OH 34.015518) | |
| 207Q00000X Family Medicine (Licence: CA 20A22433) | |
| Enumeration Date | 2019-03-24 |
| Last Update Date | 2025-01-02 |