NPI | 1659044030 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 202103044) |
Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: MO 2021030344) |
Enumeration Date | 2021-07-30 |
Last Update Date | 2022-12-01 |