| NPI | 1891871455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: OR DO26929) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OR D026929) |
| 208D00000X General Practice (Licence: ME 1826) | |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2012-01-13 |