NPI | 1417304403 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA DO-05812) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
204D00000X Neuromusculoskeletal Medicine & OMM (Licence: IA DO-05812) | |
Enumeration Date | 2016-05-19 |
Last Update Date | 2023-01-05 |