| NPI | 1366792616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: TX T3852) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: FL OS21836) |
| 207Q00000X Family Medicine (Licence: FL OS21836) | |
| Enumeration Date | 2012-09-13 |
| Last Update Date | 2025-05-27 |