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 |