| NPI | 1588989990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: UT 13453498-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60295986) |
| 207Q00000X Family Medicine (Licence: NY 275396) | |
| Enumeration Date | 2010-03-30 |
| Last Update Date | 2024-01-22 |