NPI | 1992069819 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: MI 5101019999) |
Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101019999) |
207Q00000X Family Medicine (Licence: MI 5101019999) | |
Enumeration Date | 2012-06-25 |
Last Update Date | 2023-07-25 |