| NPI | 1134157605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: FL ME 95727) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME95727) |
| 207P00000X Emergency Medicine (Licence: OH 35 123788) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: FL ME 95727) | |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2021-03-09 |