| NPI | 1831240092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: VT 032.0058141) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VT 032.0058141) |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2015-07-17 |