| NPI | 1043385370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: VA 0102036958) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: HI DOS1022) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2007-07-08 |