| NPI | 1871853796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: HI DOS-2186) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: CA 20A13464) |
| 208D00000X General Practice (Licence: CA 20A13464) | |
| Enumeration Date | 2012-05-24 |
| Last Update Date | 2023-02-04 |