| NPI | 1114912995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: IA DO-05500) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 5101014892) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: OH 34.012429) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: IA DO05500) | |
| Enumeration Date | 2005-09-16 |
| Last Update Date | 2025-08-19 |