| NPI | 1265854897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: FL UO3827) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL UO3827) |
| Enumeration Date | 2014-01-16 |
| Last Update Date | 2018-11-30 |