| NPI | 1053362822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: GA 061501) |
| Additional Taxonomies | 174400000X Specialist (Licence: VA 0101237530) |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: GA 061501) | |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: NY 240218) | |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2014-06-03 |