| NPI | 1629114376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: CT 000340) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 000340) |
| 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: MA 238085) | |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2013-03-06 |