| NPI | 1386645968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: VA 0102204013) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: MO R6C10) |
| 207Q00000X Family Medicine (Licence: VA 0102204013) | |
| 207Q00000X Family Medicine (Licence: MO R6C10) | |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2018-11-01 |