| NPI | 1891197273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: KY 04167) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 04167) |
| Enumeration Date | 2014-09-17 |
| Last Update Date | 2020-02-26 |