| NPI | 1013013101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: GA 75377) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: LA 024049) |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: GA 75377) | |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2021-10-12 |