| NPI | 1407876733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: CT 000533) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 000533) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2013-04-18 |