| NPI | 1922264175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: CO 47816) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036116605) |
| 207R00000X Internal Medicine (Licence: IL 036116605) | |
| 207R00000X Internal Medicine (Licence: CO 47816) | |
| Enumeration Date | 2008-08-06 |
| Last Update Date | 2020-05-28 |