| NPI | 1104804293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: FL ME147875) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX H6228) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: TX H6228) | |
| Enumeration Date | 2006-01-09 |
| Last Update Date | 2021-08-24 |