| NPI | 1205077591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: VT 042-0013275) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NH LT4373) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: VT 042.0013275) | |
| Enumeration Date | 2009-03-16 |
| Last Update Date | 2023-01-13 |