| NPI | 1083663967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 40617) |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: MN 40617) |
| 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: IA 03005) | |
| 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: IL 036-063775) | |
| 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: WI 37512-04) | |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: IL 036-063775) | |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: IA 03005) | |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: MN 40617) | |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: WI 37512-021) | |
| 207Q00000X Family Medicine (Licence: WI 37512-021) | |
| 207Q00000X Family Medicine (Licence: IA 03005) | |
| 207Q00000X Family Medicine (Licence: IL 036-063775) | |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2010-05-18 |