| NPI | 1952363715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 4540) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: AZ 4540) |
| 207Q00000X Family Medicine (Licence: OH 34007912) | |
| 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: OH 34007912) | |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2007-11-16 |