| NPI | 1215950092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: NY 291887) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA G74087) |
| 207QS0010X Family Medicine Sports Medicine (Licence: CA G74087) | |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: CA G74087) | |
| 222Z00000X Orthotist (Licence: CA G74087) | |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2021-02-01 |