| NPI | 1184887069 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: CO DR.0060094) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CO DR.0060094) |
| 207X00000X Orthopaedic Surgery (Licence: IL 125-055327) | |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2025-01-08 |