| NPI | 1588628770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: TX N0634) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX N0634) |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2011-10-24 |