| NPI | 1760619217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: OH 34.011553) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT013173) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: PA OS015364) | |
| Enumeration Date | 2009-06-11 |
| Last Update Date | 2021-02-09 |