| NPI | 1407829864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: TX G0289) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: SC 1536) |
| 207Q00000X Family Medicine (Licence: SC 1536) | |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2018-05-25 |