| NPI | 1518954197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: MO 2003004986) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2003004986) |
| Enumeration Date | 2005-09-29 |
| Last Update Date | 2008-02-04 |