| NPI | 1043219470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 223633) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: MA 223633) |
| 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: ME 1770) | |
| 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: NH 12658) | |
| 207Q00000X Family Medicine (Licence: ME 1770) | |
| 207Q00000X Family Medicine (Licence: NH 12658) | |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2011-03-15 |