| NPI | 1174735336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 03054) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: TN 2462) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2013-06-25 |