| NPI | 1548256308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: MA 60481) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 60481) |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2016-11-14 |