| NPI | 1710140314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: OH 34009703) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: MI 5101022929) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: VA 0102203247) | |
| Enumeration Date | 2008-07-03 |
| Last Update Date | 2023-10-10 |