| NPI | 1790885549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: CA 20A9222) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: NY 00231586) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2019-03-04 |