| NPI | 1356433783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: TN MD20857) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: TN MD20857) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: TN MD20857) | |
| Enumeration Date | 2006-09-30 |
| Last Update Date | 2022-03-31 |