| NPI | 1730383993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: FL OS9698) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL OS9698) |
| 207RA0401X Internal Medicine, Addiction Medicine (Licence: FL OS9698) | |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2013-06-03 |