| NPI | 1205950953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX J0266) |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: TX J0266) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2015-04-22 |