| NPI | 1992333793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: MD H0099050) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MD H0099050) |
| Enumeration Date | 2020-03-29 |
| Last Update Date | 2025-07-24 |