| NPI | 1043574882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: SC 51970) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 5101020130) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: KY 04105) | |
| Enumeration Date | 2012-06-26 |
| Last Update Date | 2021-03-03 |