| NPI | 1316354137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: OH AT005080) |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: OK 831) |
| 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: NC 2140) | |
| Enumeration Date | 2014-07-14 |
| Last Update Date | 2017-07-15 |