| NPI | 1306106877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS14461) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: FL OS14461) |
| 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: CA 20A18052) | |
| 207Q00000X Family Medicine (Licence: MI 5101019895) | |
| 207Q00000X Family Medicine (Licence: CA 20A18052) | |
| Enumeration Date | 2012-05-18 |
| Last Update Date | 2022-08-19 |