| NPI | 1205801990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NE 15729) |
| Additional Taxonomies | 207XS0114X Orthopaedic Surgery Adult Reconstructive Orthopaedic Surgery (Licence: NE 15729) |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: NE 15729) | |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2008-06-02 |