| NPI | 1184654568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: ME 1015) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: ME 1015) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2011-01-03 |