| NPI | 1255365730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: PR 10590) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: PR 10590) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2010-09-14 |