| NPI | 1336225796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2010-01790) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: NC 2010-01790) |
| Enumeration Date | 2006-10-28 |
| Last Update Date | 2015-06-08 |