| NPI | 1821142829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: FL OS6403) |
| Additional Taxonomies | 133N00000X Nutritionist |
| 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: FL 0006403) | |
| 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: FL OS6403) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: FL os6403) | |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2018-06-16 |