| NPI | 1184815730 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: ME DO1967) | 
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: ME 1967) | 
| Enumeration Date | 2007-08-08 | 
| Last Update Date | 2022-09-23 |