| NPI | 1205925070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: LA MD015745) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: LA MD.015745) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2008-09-17 |