| NPI | 1073787065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NC 2023-02613) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: IL 036122807) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NJ 25MA07771600) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: WI 51640020) | |
| Enumeration Date | 2008-04-22 |
| Last Update Date | 2023-09-15 |