| NPI | 1356404909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: PR 10501) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 10501) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2007-07-08 |