is a Sports Medicine in , . practices all healthcare services and medical treatments related to Sports Medicine. The NPI Number for is 1871702175. The last update date is .
's current location address is , , . You can contact this provider via phone number . The mailing address for is , , . To know further, please read the information below!
Provider Profile Detail
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| Address | , , |
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| Sole Proprietor | -- |
| Credentials | -- |
NPI Number Detail
| NPI Number | 1871702175 |
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| Provider Enumeration Date | |
| Last Updated Date |
Provider Mailing Address Detail
| Address | |
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| State | () |
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Provider's Primary Taxonomy Detail
| Speciality | Sports Medicine |
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| Taxonomy | 207Xx0005X |
| Licence No | 32420 |
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Definition: An orthopaedic surgeon trained in sports medicine provides appropriate care for all structures of the musculoskeletal system directly affected by participation in sporting activity. This specialist is proficient in areas including conditioning, train |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 1326287434 | SC | MEDICAID DME NPI # | |
| 324205 | SC | -- |
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