| NPI | 1023096948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: LA MD.204132) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MN 44712) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MO 2007022052) | |
| Enumeration Date | 2006-01-03 |
| Last Update Date | 2010-09-24 |