NPI | 1073583035 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 3119) |
Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: AZ 3119) |
Enumeration Date | 2006-01-24 |
Last Update Date | 2012-05-09 |