| NPI | 1891057691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MO 2016026999) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME117011) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MO 2016026999) | |
| Enumeration Date | 2012-06-08 |
| Last Update Date | 2020-07-16 |