| NPI | 1780650101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: VA 0101030715) |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: FL ME 84809) |
| Enumeration Date | 2006-02-25 |
| Last Update Date | 2010-02-11 |