| NPI | 1073645099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: NV 1000045-521) |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: NV 1000045-521) |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2007-07-08 |