| NPI | 1750310215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: FL ME0054778) |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: FL ME0054778) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2012-07-30 |