| NPI | 1477998599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP61475133) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: FL OS14868) |
| 207Q00000X Family Medicine (Licence: FL Os14868) | |
| Enumeration Date | 2013-05-02 |
| Last Update Date | 2024-04-29 |