| NPI | 1275761991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 006017) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: VA 0102206528) |
| 207Q00000X Family Medicine (Licence: AZ R1704) | |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2021-04-30 |