| NPI | 1275522625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: WI 50942) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: AZ 33787) |
| Enumeration Date | 2005-10-18 |
| Last Update Date | 2011-04-13 |