| NPI | 1366517005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: FL ME140212) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA C152920) |
| 207Q00000X Family Medicine (Licence: MI 4301085697) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: MA 266010) | |
| 207XX0801X Orthopaedic Surgery, Orthopaedic Trauma (Licence: GA 85016) | |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2020-06-22 |