NPI | 1164582656 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CA A107642) |
Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: TX N6562) |
Enumeration Date | 2006-12-12 |
Last Update Date | 2012-10-24 |