| NPI | 1043205248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: IL 036-056023) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: IL 036-056023) |
| Enumeration Date | 2005-09-14 |
| Last Update Date | 2010-02-05 |