NPI | 1508874439 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: FL 057703) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 057703) |
Enumeration Date | 2006-08-04 |
Last Update Date | 2010-03-26 |