| NPI | 1558855262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: MI 5101024167) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MI 5101025191) |
| Enumeration Date | 2018-06-15 |
| Last Update Date | 2023-06-29 |