| NPI | 1033302385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: MS 21938) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: NC 2013-01470) |
| Enumeration Date | 2007-08-21 |
| Last Update Date | 2022-06-16 |