| 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 |