| NPI | 1184698128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: FL OS0005899) |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: FL OS0005899f) |
| 207Q00000X Family Medicine (Licence: FL OS0005899) | |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2012-09-11 |