| NPI | 1982010559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: CA 15474) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 260598) |
| Enumeration Date | 2014-07-03 |
| Last Update Date | 2022-07-21 |