| NPI | 1194091579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: NY 277334) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: CT 60175) |
| 207X00000X Orthopaedic Surgery (Licence: CA A147331) | |
| 207X00000X Orthopaedic Surgery (Licence: NY 277334) | |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: CT 60175) | |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: CA A147331) | |
| Enumeration Date | 2012-03-29 |
| Last Update Date | 2019-02-07 |