| NPI | 1487073433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MI 4301500490) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301500490) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MI 4301500490) | |
| 207Q00000X Family Medicine (Licence: PA MD464546) | |
| Enumeration Date | 2014-04-07 |
| Last Update Date | 2025-10-23 |