| NPI | 1134119167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: AZ 25805) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: SC 36658) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CO 38539) | |
| Enumeration Date | 2005-10-21 |
| Last Update Date | 2020-09-10 |