| NPI | 1245590744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: CO DR.0063253) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NE 27482) |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: CA A171296) | |
| Enumeration Date | 2012-05-18 |
| Last Update Date | 2022-08-31 |