| NPI | 1285688002 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 208D00000X General Practice (Licence: PA OS 004131L) | 
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: PA OS-004131L) | 
| Enumeration Date | 2006-05-19 | 
| Last Update Date | 2008-05-30 |