| NPI | 1881695849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: KY 03613) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: MI 5101015512) |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2014-07-17 |