| NPI | 1487040440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 007705) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: AZ 007705) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-07 |
| Last Update Date | 2019-10-17 |