| NPI | 1245237858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: MO R1J92) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MO R1J92) |
| Enumeration Date | 2005-06-29 |
| Last Update Date | 2019-09-23 |