| NPI | 1992742977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: PA OS015425) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL DO-495) |
| 207Q00000X Family Medicine (Licence: PA OS015425) | |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2016-02-01 |