| NPI | 1548623044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: OH 34.014991) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34.014991) |
| Enumeration Date | 2016-04-01 |
| Last Update Date | 2024-04-03 |