| NPI | 1326088980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: ME T0539) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME 1954) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2010-07-30 |