| NPI | 1154814689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: PA MD490263) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: MA 1018927) |
| 207Q00000X Family Medicine (Licence: PA MT215978) | |
| 207Q00000X Family Medicine (Licence: MA 1018927) | |
| 207Q00000X Family Medicine (Licence: MI 4301507410) | |
| Enumeration Date | 2018-06-09 |
| Last Update Date | 2025-11-05 |