| NPI | 1235440918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: CT 54472) |
| Additional Taxonomies | 174400000X Specialist |
| 207X00000X Orthopaedic Surgery (Licence: PA MT197555) | |
| Enumeration Date | 2010-06-28 |
| Last Update Date | 2022-07-21 |