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 |