| NPI | 1366651895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083S0010X Preventive Medicine, Sports Medicine (Licence: CA G85733) |
| Additional Taxonomies | 2084P0015X Psychiatry & Neurology, Psychosomatic Medicine (Licence: CA G85733) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2013-06-02 |