| NPI | 1861885592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS026003) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34.014281) |
| 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: OH 34.014281) | |
| Enumeration Date | 2015-03-05 |
| Last Update Date | 2026-09-28 |