| NPI | 1952621872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine (Licence: WI 73430) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5101018776) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MI 5101018776) | |
| 208000000X Pediatrics (Licence: MI 5101018776) | |
| Enumeration Date | 2010-06-02 |
| Last Update Date | 2021-12-06 |