| NPI | 1679013437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: FL OS16342) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL OS16342) |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: FL OS16342) | |
| Enumeration Date | 2017-02-27 |
| Last Update Date | 2024-11-05 |