| NPI | 1265402440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: OR DO26923) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR DO26923) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2022-04-22 |