| NPI | 1295914299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: WI 49791) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: WI 49791-021) |
| 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: WI 49791) | |
| Enumeration Date | 2007-10-26 |
| Last Update Date | 2023-06-01 |