| NPI | 1700267481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX R0188) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: TX BP10053130) |
| 207Q00000X Family Medicine (Licence: TX BP10053130) | |
| Enumeration Date | 2015-06-18 |
| Last Update Date | 2016-10-24 |