| NPI | 1770907867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: MI 5101022939) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0102204454) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-02-10 |
| Last Update Date | 2023-03-14 |