| NPI | 1861477598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 042536) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: GA 042536) |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2010-09-13 |