| NPI | 1023122421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AL 7957) |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: AL 00007957) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2013-03-25 |