| NPI | 1730158965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA DO306658R) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: LA MD.06658R) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2017-04-10 |