| NPI | 1588680821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: FL os9490) |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: FL os9490) |
| 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: FL os9490) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2011-10-19 |