| NPI | 1861697948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: FL ME115003) |
| Additional Taxonomies | 2084N0600X Psychiatry & Neurology Clinical Neurophysiology (Licence: KY 40010) |
| 2084N0600X Psychiatry & Neurology Clinical Neurophysiology (Licence: LA 203269) | |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2023-09-12 |