| NPI | 1437221322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WV 22568) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: WV 22568) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: WV 22568) | |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2022-04-18 |