| NPI | 1336266097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR DO151041) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: OR DO151041) |
| 207Q00000X Family Medicine (Licence: ME 2075) | |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2026-05-12 |