| NPI | 1700878287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: NV 280) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV 280) |
| Enumeration Date | 2005-08-19 |
| Last Update Date | 2012-07-13 |