| NPI | 1033223730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: OK 3862) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX N3810) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: TX N3810) | |
| 207X00000X Orthopaedic Surgery (Licence: TX N3810) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MS 19051) | |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2021-07-29 |