| NPI | 1366633851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: CO DR.0057282) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: NY 258525) |
| Enumeration Date | 2007-08-08 |
| Last Update Date | 2022-05-10 |