| NPI | 1689832412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: UT 9469694-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 9469694-1204) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: UT 9469694-1204) | |
| Enumeration Date | 2008-05-29 |
| Last Update Date | 2019-07-10 |