| NPI | 1013910850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NC 9400741) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: NC 9400741) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2021-05-06 |