| NPI | 1629029822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 3485) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: IA 3485) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2015-01-22 |