| NPI | 1730593518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0059173) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: CO DR.0059173) |
| 207Q00000X Family Medicine (Licence: MI 5101021335) | |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2019-04-04 |