| NPI | 1194752923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WI 31628) |
| Additional Taxonomies | 207XS0114X Orthopaedic Surgery Adult Reconstructive Orthopaedic Surgery (Licence: WI 31628) |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: WI 31628) | |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2023-03-07 |