| NPI | 1275599664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WI 62739) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MO 2005030638) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: WI 62739) | |
| 207X00000X Orthopaedic Surgery (Licence: MN 65738) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: WI 829-039) | |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2020-09-16 |