| NPI | 1962815068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: MT 101361) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: CA 20A16491) |
| 207Q00000X Family Medicine (Licence: MT 101361) | |
| 207Q00000X Family Medicine (Licence: CA 20A16491) | |
| Enumeration Date | 2014-06-05 |
| Last Update Date | 2021-12-01 |