| NPI | 1376861203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: NC NC2014-00538) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NC NC2014-00538) |
| 208000000X Pediatrics (Licence: NC NC2014-00538) | |
| Enumeration Date | 2010-05-17 |
| Last Update Date | 2022-06-03 |