| 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 |