| NPI | 1285080796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: UT 11099671-1204) |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: UT 110996711204) |
| 208D00000X General Practice (Licence: OR DO187716) | |
| Enumeration Date | 2016-05-13 |
| Last Update Date | 2025-03-19 |