NPI | 1184814576 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MO 2007018123) |
Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MO 2007018123) |
Enumeration Date | 2007-07-31 |
Last Update Date | 2018-12-27 |