| NPI | 1952663601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS017495) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT014920) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: PA OS017495) | |
| Enumeration Date | 2012-06-08 |
| Last Update Date | 2016-06-21 |