| NPI | 1841787751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX T3767) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: TX T3767) |
| 207Q00000X Family Medicine (Licence: TX T3767) | |
| Enumeration Date | 2018-04-16 |
| Last Update Date | 2022-01-03 |