| NPI | 1962844779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX T4795) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2021020673) |
| 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: TX T4795) | |
| Enumeration Date | 2013-07-22 |
| Last Update Date | 2026-04-22 |