| NPI | 1235384637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: MD D88572) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA MD459783) |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: CA A131279) | |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: FL ME113027) | |
| Enumeration Date | 2008-11-26 |
| Last Update Date | 2021-11-08 |