| NPI | 1225080476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: ND NA) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI MI43084882) |
| 207X00000X Orthopaedic Surgery (Licence: ND 8133) | |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2020-12-30 |