| NPI | 1588103659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX BP10058782) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: FL OS17843) |
| 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: TX R8700) | |
| 207Q00000X Family Medicine (Licence: FL OS17843) | |
| 207Q00000X Family Medicine (Licence: TX R8700) | |
| Enumeration Date | 2017-02-21 |
| Last Update Date | 2021-06-23 |