| NPI | 1790279495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: KY TP867) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME TP18010) |
| 207Q00000X Family Medicine (Licence: OH 34.016142) | |
| Enumeration Date | 2018-06-18 |
| Last Update Date | 2023-11-27 |