| NPI | 1033353354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: AZ 46961) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: AZ 46961) |
| Enumeration Date | 2009-04-30 |
| Last Update Date | 2020-09-08 |