| NPI | 1740243567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: FL ME71434) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME71434) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: FL ME71434) | |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2023-10-11 |