| NPI | 1710133228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: VA 0102202984) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME 2227) |
| 207Q00000X Family Medicine (Licence: VA 0102202984) | |
| Enumeration Date | 2008-08-15 |
| Last Update Date | 2013-08-05 |