| NPI | 1245213057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NC 96-001360) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NC 96-001360) |
| Enumeration Date | 2005-11-25 |
| Last Update Date | 2010-05-12 |