| NPI | 1891706693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: VT 042-0009008) |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: NH 9254) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2007-07-08 |