| NPI | 1982018727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: MO 2016007756) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2016007756) |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2022-01-04 |