| NPI | 1083092167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NC 2022-02432) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: AL MD.39351) |
| 207X00000X Orthopaedic Surgery (Licence: IL 036154470) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: AL MD.39351) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: IL 036154470) | |
| Enumeration Date | 2015-05-11 |
| Last Update Date | 2022-09-21 |