| NPI | 1083855696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: PR 21211) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: NY 284074) |
| Enumeration Date | 2009-03-11 |
| Last Update Date | 2019-09-12 |