| NPI | 1205895000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WV 21528) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: WV 21528) |
| 207X00000X Orthopaedic Surgery (Licence: FL ME135821) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: FL ME135821) | |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2021-11-17 |