NPI | 1740571280 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: TX N7458) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX N7459) |
207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: TX N7459) | |
Enumeration Date | 2011-05-02 |
Last Update Date | 2022-01-28 |