| NPI | 1013086917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: PA OS013311) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL OS16689) |
| 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: PA OS013311) | |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2023-01-31 |