| NPI | 1083615694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NC 200600861) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NC 200600861) |
| Enumeration Date | 2005-08-04 |
| Last Update Date | 2020-01-08 |