| NPI | 1215915111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: PA OS014838) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS014838) |
| 207Q00000X Family Medicine (Licence: MN 47004) | |
| Enumeration Date | 2006-01-03 |
| Last Update Date | 2020-08-05 |