| NPI | 1902005762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 89309) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: MI 5101016264) |
| 207Q00000X Family Medicine (Licence: MI 5101016264) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: ME 2013) | |
| Enumeration Date | 2007-07-12 |
| Last Update Date | 2023-09-21 |