| NPI | 1124178421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: MI 5101010112) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: IA 02797) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2007-07-08 |