| NPI | 1508852765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: MI 5101010763) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI HS010763) |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2018-12-10 |