| NPI | 1740509298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: VA 0102205457) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: OH 34.011059) |
| Enumeration Date | 2010-05-24 |
| Last Update Date | 2019-04-23 |