| NPI | 1811341415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 68496) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: MN 68496) |
| 208D00000X General Practice (Licence: MO 2018039614) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-20 |
| Last Update Date | 2022-11-16 |