| NPI | 1760866545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: GA 82840) |
| Additional Taxonomies | 2084N0008X Psychiatry & Neurology, Neuromuscular Medicine (Licence: GA 82840) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: KY R3705) | |
| Enumeration Date | 2015-07-12 |
| Last Update Date | 2022-09-07 |