| NPI | 1407951130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 42344-21) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: WI 42344) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2016-10-17 |