| NPI | 1427432541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS14420) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: FL 14420) |
| 207R00000X Internal Medicine (Licence: FL OS14420) | |
| Enumeration Date | 2015-07-18 |
| Last Update Date | 2025-01-10 |