| NPI | 1114232584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: MA 279757) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MA 279757) |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: AZ 52843) | |
| Enumeration Date | 2010-08-10 |
| Last Update Date | 2019-11-05 |