NPI | 1790778439 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: CA 20A11811) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A11811) |
Enumeration Date | 2005-08-29 |
Last Update Date | 2023-06-14 |