| NPI | 1376573030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: CA C50556) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA C50556) |
| 208M00000X Hospitalist (Licence: CA C50556) | |
| 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: OH 35.045782) | |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2014-05-08 |