| NPI | 1235699299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: OH 34.015518) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34.015518) |
| Enumeration Date | 2019-03-24 |
| Last Update Date | 2024-03-04 |