| NPI | 1073768917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MI 4301093528) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX M9678) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MI 4301093528) | |
| Enumeration Date | 2008-11-19 |
| Last Update Date | 2018-05-30 |