| NPI | 1821060633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: NM 2001-331) |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: CA C41531) |
| 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: CO 26994) | |
| 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: MI 38254) | |
| Enumeration Date | 2006-02-06 |
| Last Update Date | 2007-07-09 |