| NPI | 1790842805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: AK 7932) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 4166) |
| 207Q00000X Family Medicine (Licence: AK 7932) | |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2023-03-07 |