| NPI | 1205254042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: UT 11265776-1205) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: UT 11265776-1205) |
| Enumeration Date | 2014-03-30 |
| Last Update Date | 2019-06-10 |