| NPI | 1104246560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: GA 95224) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CO DR.0067914) |
| 207X00000X Orthopaedic Surgery (Licence: IA MD-46304) | |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: CO DR.0067914) | |
| Enumeration Date | 2014-04-23 |
| Last Update Date | 2023-07-31 |