| NPI | 1518373208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: PA OS017870) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT015644) |
| 207Q00000X Family Medicine (Licence: PA OS017870) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: PA OS017870) | |
| Enumeration Date | 2014-07-02 |
| Last Update Date | 2023-01-24 |