| NPI | 1710228671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: KY 05005) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34.011962) |
| Enumeration Date | 2013-03-01 |
| Last Update Date | 2024-06-28 |