| NPI | 1700345766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA DO-06013) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: IA DO-06013) |
| Enumeration Date | 2019-03-18 |
| Last Update Date | 2025-09-23 |