| NPI | 1235129487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NC 2011-01365) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MD426809) |
| 207X00000X Orthopaedic Surgery (Licence: VA 0101243787) | |
| 207X00000X Orthopaedic Surgery (Licence: TN MD049632) | |
| 207X00000X Orthopaedic Surgery (Licence: NC 2011-01365) | |
| Enumeration Date | 2005-10-27 |
| Last Update Date | 2016-09-19 |