| NPI | 1992291900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MI 5101025718) |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: MI 5101025718) |
| 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: MI 5101025718) | |
| Enumeration Date | 2018-07-03 |
| Last Update Date | 2023-01-09 |