| NPI | 1407437049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: OH 34.017391) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA 61340785) |
| Enumeration Date | 2021-04-15 |
| Last Update Date | 2025-10-06 |