| NPI | 1861653560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: NV DO1666) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: CA 20A9728) |
| 207Q00000X Family Medicine (Licence: NV DO1666) | |
| 207Q00000X Family Medicine (Licence: CA 20A9728) | |
| Enumeration Date | 2008-06-24 |
| Last Update Date | 2020-10-28 |