| NPI | 1417002965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: MS 20669) |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine (Licence: MO 2006008801) |
| 207QS0010X Family Medicine Sports Medicine (Licence: IL 036-100695) | |
| 207X00000X Orthopaedic Surgery (Licence: MS 20669) | |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2018-05-01 |