| NPI | 1275797227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NE 28488) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: MI 4301095369) |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: MN 57780) | |
| Enumeration Date | 2008-07-17 |
| Last Update Date | 2015-09-14 |