| NPI | 1790341808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2026-02994) |
| Additional Taxonomies | 202D00000X Integrative Medicine (Licence: NC 2026-02994) |
| 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: NC 2026-02994) | |
| Enumeration Date | 2019-05-14 |
| Last Update Date | 2026-06-20 |