| 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 |