| NPI | 1114944907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: NC 9901001) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: IA 02184) |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2023-03-07 |