| NPI | 1083678452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: FL ME85839) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL ME85839) |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: TX S8206) | |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2022-11-11 |