NPI | 1376702183 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS9641) |
Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: FL OS9641) |
Enumeration Date | 2008-06-06 |
Last Update Date | 2017-01-05 |