| NPI | 1366677437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: MI 4301109849) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: OH 35098143) |
| Enumeration Date | 2009-05-19 |
| Last Update Date | 2022-07-21 |