| NPI | 1255697967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: SC MD51972) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NM MD2017-0982) |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: SC MD51972) | |
| Enumeration Date | 2012-04-06 |
| Last Update Date | 2020-03-13 |