| NPI | 1336889096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 85367-20) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: WI 85367-20) |
| 2080S0010X Pediatrics, Sports Medicine (Licence: WI 85367-20) | |
| 207X00000X Orthopaedic Surgery (Licence: WI 85367-20) | |
| Enumeration Date | 2022-03-30 |
| Last Update Date | 2026-08-12 |