| NPI | 1770614398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: KY 20399) |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: KY 20399) |
| 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: KY 20399) | |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2009-03-03 |