| NPI | 1154379261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CT 31391) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CT 031391) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CT 31391) | |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2021-07-23 |