| NPI | 1124007125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: PA OS010713L) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: PA OS010713L) |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2017-01-04 |