| NPI | 1639592181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: TX S8324) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 280771) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: OK 6005) | |
| 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: OK 6005) | |
| Enumeration Date | 2014-02-03 |
| Last Update Date | 2024-03-05 |