| NPI | 1205065877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: TX P3579) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS10717) |
| 207Q00000X Family Medicine (Licence: TX P3579) | |
| Enumeration Date | 2009-07-04 |
| Last Update Date | 2016-01-26 |