| NPI | 1861839912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: MI 5101020573) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101020573) |
| Enumeration Date | 2013-05-30 |
| Last Update Date | 2022-08-05 |