| NPI | 1619903846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: WI 63011-21) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: AZ 3247) |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2019-04-17 |