| NPI | 1376694679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: PA 0S006325L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34006374) |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2023-04-20 |