| NPI | 1639583206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MI 5315088343) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: MI 5101021238) |
| 207Q00000X Family Medicine (Licence: MI 5101021238) | |
| Enumeration Date | 2014-06-11 |
| Last Update Date | 2019-12-16 |