| NPI | 1265582712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: SD 8925) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NE 25765) |
| 207X00000X Orthopaedic Surgery (Licence: IA 41240) | |
| 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NE 25765) | |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2013-11-15 |