| NPI | 1124021951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NC 91-00191) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NC 93-00191) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2017-10-23 |