| NPI | 1760809966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: TX S5999) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NM MD2019-0534) |
| Enumeration Date | 2014-03-25 |
| Last Update Date | 2025-08-27 |