| NPI | 1386904225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: TX S4821) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: NY 283559) |
| 207Q00000X Family Medicine (Licence: TX S4821) | |
| 207Q00000X Family Medicine (Licence: NY 283559) | |
| Enumeration Date | 2012-05-25 |
| Last Update Date | 2020-07-14 |