| NPI | 1679914469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: CA 20A13620) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A13620) |
| Enumeration Date | 2013-07-10 |
| Last Update Date | 2021-12-01 |