| NPI | 1609021104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: AR E-12201) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: MO 2007018743) |
| 208D00000X General Practice (Licence: AR E-12201) | |
| 208D00000X General Practice (Licence: MO 2007018743) | |
| Enumeration Date | 2008-11-25 |
| Last Update Date | 2023-03-20 |