| NPI | 1114059136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: GA 0018845) |
| Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine (Licence: GA 0018845) |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2007-07-08 |