| NPI | 1881680510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MT 50485) |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: WI 36872-020) |
| Enumeration Date | 2005-09-27 |
| Last Update Date | 2021-11-24 |