| 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 |