| NPI | 1710920707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine Geriatric Medicine (Licence: TX E5927) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: TX E5927) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2016-05-11 |