| NPI | 1962653220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS015989) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: PA OS015989) |
| 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: PA OS015989) | |
| Enumeration Date | 2008-10-06 |
| Last Update Date | 2017-01-16 |