| NPI | 1710931613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: AK MEDO5183) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK MEDO5183) |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2026-08-28 |