| NPI | 1386963999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: CA C159710) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: FL ME124053) |
| 207Q00000X Family Medicine (Licence: GA 069576) | |
| Enumeration Date | 2010-05-21 |
| Last Update Date | 2019-02-27 |