| NPI | 1669705372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: MS 22621) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS10752) |
| Enumeration Date | 2009-09-13 |
| Last Update Date | 2013-07-29 |