| NPI | 1205492477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS18158) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: FL OS18158) |
| Enumeration Date | 2019-05-14 |
| Last Update Date | 2023-08-16 |