| NPI | 1700999398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS8517) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: FL OS8517) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2014-05-06 |