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 |