| NPI | 1114205101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WI 60217) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: WI 60217) |
| Enumeration Date | 2011-07-26 |
| Last Update Date | 2023-11-07 |