| NPI | 1508923848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: TX J9427) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: OH 34-00-5836-W) |
| 207Q00000X Family Medicine (Licence: TX J9427) | |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2012-03-27 |