| NPI | 1063628295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: CT 16587) |
| Additional Taxonomies | 2084P0015X Psychiatry & Neurology, Psychosomatic Medicine (Licence: CT 16587) |
| 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: CT 16587) | |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2013-12-26 |