| NPI | 1942389705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: VA 0102206847) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OS 006880L) |
| 207Q00000X Family Medicine (Licence: PA OS006880L) | |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2021-09-07 |