| NPI | 1376673178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: FL ME0046399) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: FL ME0046399) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2007-07-09 |