| NPI | 1114911492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CO DR.0067561) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0067561) |
| 207X00000X Orthopaedic Surgery (Licence: CO DR.0067561) | |
| Enumeration Date | 2005-09-01 |
| Last Update Date | 2024-09-29 |