| NPI | 1639171598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: PA OS003496L) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA OS003496L) |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2016-02-01 |