| NPI | 1750311833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: OR DO16364) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: CO 28988) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2009-10-27 |