| NPI | 1831220292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NC 200500275) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NC 200500275) |
| 208D00000X General Practice (Licence: NC 200500275) | |
| 207Q00000X Family Medicine (Licence: NC 200500275) | |
| 207RS0010X Internal Medicine, Sports Medicine (Licence: NC 200500275) | |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2024-07-15 |