| NPI | 1518924984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NH 12931) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NH 12931) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NH 12931) | |
| Enumeration Date | 2006-04-28 |
| Last Update Date | 2023-11-16 |