| NPI | 1619453206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: VA 0116038484) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KY 607) |
| Enumeration Date | 2018-07-17 |
| Last Update Date | 2023-06-23 |