NPI | 1770780124 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: CO 50054) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 50054) |
Enumeration Date | 2007-06-29 |
Last Update Date | 2012-02-14 |