| NPI | 1427036656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 024150) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: LA L024150) |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: LA L024150) | |
| 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: LA L024150) | |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2007-07-08 |