| NPI | 1982657375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M8339) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: ID M-8339) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2017-10-03 |