| NPI | 1114459294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: GA 92346) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NC 227233) |
| Enumeration Date | 2017-03-29 |
| Last Update Date | 2023-08-31 |