| NPI | 1336387828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS014378) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: PA OS014378) |
| Enumeration Date | 2009-01-22 |
| Last Update Date | 2022-07-21 |