| NPI | 1861885592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: OH 34.014281) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34.014281) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-03-05 |
| Last Update Date | 2020-10-07 |