NPI | 1780983437 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: OH 3401178) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 58.004005) |
207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: OH 3401178) | |
Enumeration Date | 2011-03-21 |
Last Update Date | 2023-03-07 |