| NPI | 1104821958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CT 038621) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CT 038621) |
| Enumeration Date | 2005-06-17 |
| Last Update Date | 2022-07-11 |