| NPI | 1043709652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: SC 89615) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 4301114781) |
| Enumeration Date | 2018-05-09 |
| Last Update Date | 2023-07-19 |