| NPI | 1770555310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 3943) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: IN 02004216A) |
| 207Q00000X Family Medicine (Licence: IN 02004216A) | |
| 207Q00000X Family Medicine (Licence: OH 34006659S) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: OH 34006659S) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: IA 3943) | |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2018-12-20 |