| NPI | 1912490905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: MI 5101026336) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: MI 5101024138) |
| Enumeration Date | 2018-06-13 |
| Last Update Date | 2021-07-08 |