| NPI | 1285080796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: UT 11099671-1204) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OR DO187716) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-05-13 |
| Last Update Date | 2021-09-16 |