| NPI | 1124012000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: AR E476114) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MO 2003014160) |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2009-10-08 |