| NPI | 1578950804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: MI 1578950804) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101021600) |
| Enumeration Date | 2015-04-24 |
| Last Update Date | 2025-04-10 |