| NPI | 1164657854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: ID M-12928) |
| Additional Taxonomies | 208600000X Surgery (Licence: ID M-12928) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: ID M-12928) | |
| Enumeration Date | 2009-05-25 |
| Last Update Date | 2018-08-01 |