| NPI | 1861464505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: WV 32407) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: TX L8232) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MD D68048) | |
| Enumeration Date | 2006-02-06 |
| Last Update Date | 2025-07-29 |