| NPI | 1063679553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: FL ME117228) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: TX P7722) |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2024-04-04 |