| NPI | 1285096354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 56597) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY R4008) |
| 207RS0010X Internal Medicine, Sports Medicine (Licence: KY 56597) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: TN 62127) | |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2022-07-20 |