| NPI | 1902335912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NC 202002832) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MI 1902335912) |
| Enumeration Date | 2017-06-05 |
| Last Update Date | 2024-04-26 |