| NPI | 1265438907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: MN 41115) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: WI 44466) |
| Enumeration Date | 2005-06-27 |
| Last Update Date | 2015-06-30 |