| NPI | 1902802754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 113305) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: MO 13305) |
| 207P00000X Emergency Medicine (Licence: MO 113305) | |
| Enumeration Date | 2005-06-27 |
| Last Update Date | 2021-10-28 |