| NPI | 1588074546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OT015934) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: PA OS018386) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: PA OS018386) | |
| Enumeration Date | 2014-04-30 |
| Last Update Date | 2026-03-05 |