| NPI | 1912968223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: GA 057453) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: PA OS004445L) |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2016-03-08 |